商业保险公司参与新型农村合作医疗业务的原因分析:基于6区县的案例研究

Analyzing Incentives for Commercial Insurance Companies Prticipating in the Operation of New Cooperative Medical Scheme Business: A Case Study in 6 Counties

商业保险公司参与新型农村合作医疗业务动机包括:延续政企合作、加强与政府联系、构建政企合作新平台、社会医疗保险对商业健康保险的互补性、市场竞争的需求、拓展新市场的需求、广告效应、公司文化和企业发展战略的需求等。政府将新型农村合作医疗委托给商业保险公司,有预算不足、编制缺乏、缺少经验、职能转变、政府公信力、业务能力以及保险公司积极性等原因。随着新型农村合作医疗信息系统和支付方式的迅速改进,新型农村合作医疗经办效率大大提高,商业保险公司参与新型农村合作医疗业务的必要性在逐渐丧失。建议政府在与商业保险公司合作中,要防止商业公司的"逐利性"可能造成的公共利益损失。

Incentives for Commercial Insurance Companies （CIC） participating in the operation of new cooperative medical scheme （NCMS） business include to keep cooperationship between government and CIC, the complementary characteristics between products of commercial and social health insurance schemes, pressure of market competation, company culture, and strategic need for business development. Reasons for government consignating NCMS business to CIC including no sufficient staff and budget, lack of experience for heahh insurance management, government role transition, public trust for government, capacity of business management, and CIC＇s enthusiasm to participating in. Along with the rapid development of NCMS information system and payment method, the efficiency for business operation has improved dramatically and necessity for participation of CIC does not exist gradually. For areas continuing cooperation with CIC, the government should take an eye on posisble ｜oss of public interest.